Incidental Findings of Brugada Syndrome Type-1 and Epsilon-Like Pattern in Otherwise Healthy Man: a Case Report

Background: Brugada Syndrome (BrS) and arrhythmogenic right ventricle dysplasia (ARVD) are rare cardiomyopathies predisposing to sudden cardiac death (SCD). Comprehending the electrocardiographic features of these cardiomyopathies are crucial especially in emergency settings.Case presentation: A 25-year old medical student presented with no complaints, but had episodes of syncope, chest pain, and palpitations of unknown origin 10 years ago. The initial assessment showed stable hemodynamics. During examination, the ECG demonstrated incomplete right bundle branch block, Brugada-type 1 pattern, with signs of Epsilon wave. The following year, assessment of the ECG was repeated and findings were found suggestive of Brugada syndrome, although his echocardiography showed no structural abnormality. According to ESC guidelines, asymptomatic Brugada patients should undergo electrophysiology study.Conclusion: Careful follow-up with electrophysiology study is recommended for this patient in order to identify the likelihood of true Brugada and suitability for radiofrequency ablation or implantation of implantable cardioverter defibrillator (ICD).

Research on Dynamic Assessment Method of Earthquake Scene Rescue Performance Based on AHP and Cloud Model

In view of the ambiguity and randomness of the assessment of earthquake scene rescue performance, this paper proposes an integrated assessment method considering quantitative and qualitative influencing factors from three levels: search, rescue and medical treatment. Firstly, this study constructs an assessment index system of rescue performance at the earthquake scene based on the International Search and Rescue Advisory Group (INSARAG) guidelines set by International Search and Response. Secondly, the subjective weights and objective weights of each index were calculated using the hierarchical analysis process (AHP) and cloud model, respectively. The comprehensive weights were calculated using weighted analysis, and the performance assessment results were visually expressed by cloud model images. Finally, the study was applied to an earthquake rescue case with an initial assessment of 4.0065, and its performance was improved by 4.36% when the rescue process was optimized. The assessment results show that earthquake rescue performance can be estimated, and the rationality and effectiveness of the method was validated.

Ulnar variance in distal radial fractures: assessment and interpretation

We explored patterns of shortening of the distal radius and investigated the effect of displacement on ‘ulnar variance’ in 250 patients with distal radial fractures. A small number of patients (5%) had a fracture that resulted in true shortening. Thirty-two per cent had fractures that appeared short, but lateral radiographs revealed that the articular surface was tilted, with either the anterior or dorsal rim of the articular surface being proximal to the distal ulna but the other rim was distal to it. We recommend initial assessment of variance on lateral radiographs. If the anterior and dorsal rims of the distal radial articular surface are proximal to the distal ulna, then true shortening is present and lengthening and stabilization, to hold the radius distracted, should be considered. If only one rim is proximal to the distal ulna, then correction of the tilt will lessen the apparent positive variance. Level of evidence: IV

Cardiovascular Characteristics of Patients with Genetic Variation in Desmoplakin (DSP)

Background: Variants in the desmoplakin (DSP) gene have been recognized in association with the pathogenesis of arrhythmogenic right ventricular cardiomyopathy (ARVC) for nearly 20 years. More recently, genetic variation in DSP has also been associated with left-dominant arrhythmogenic cardiomyopathy. Data regarding the cardiac phenotypes associated with genetic variation in DSP have been largely accumulated from phenotype-first studies of ARVC. Methods: We aimed to evaluate the clinical manifestations of cardiac disease associated with variants in DSP through a genotype-first approach employed in the University of Pennsylvania Center for Inherited Cardiovascular Disease registry. We performed a retrospective study of 19 individuals with “pathogenic” or “likely pathogenic” variants in DSP identified by clinical genetic testing. Demographics and clinical characteristics were collected. Results: Among individuals with disease-causing variants in DSP, nearly 40% had left ventricular enlargement at initial assessment. Malignant arrhythmias were prevalent in this cohort (42%) with a high proportion of individuals undergoing primary and secondary prevention implantable cardioverter defibrillator implantation (68%) and ablation of ventricular arrhythmias (16%). Probands also experienced end-stage heart failure requiring heart transplantation (11%). Conclusions: Our data suggest DSP cardiomyopathy may manifest with a high burden of heart failure and arrhythmic events, highlighting its importance in the pathogenesis of dilated and arrhythmogenic cardiomyopathies. Targeted strategies for diagnosis and risk stratification for DSP cardiomyopathy should be investigated.

Safety and Risk of Operating Facilities: Rapid Assessment Methodology

Two methods for methodology uses “risk indices” (dam condition index I), as well as “fuzzy logic methods” to combine the original quantitative and qualitative (expert) information on the operated dam condition. The approach applied is in accordance with the recommendations of IEC 31010: 2019. Risk Management — Risk Assessment Techniques. Deterministic assessments of the condition in the form of “risk indices” were also used as input data in assessing the probability of the failure and in developing a probabilistic risk assessment methodology. The original database, as well as the damage assessment scale, modified in the course of the research, summarize the experience of surveys and examination of safety declarations of more than 180 hydraulic works in Russia. A description is given of the methods of initial assessment and digitization (quantification) of the condition index I, as well as combining the initial quantitative and qualitative (expert) information about various damages. The practical feasibility and the possibility of categorizing (with fuzzy boundaries) conditions and levels of damage to hydraulic structures are shown. With regard to various conditions and levels of damage, proposals are made for practical actions to ensure the safety of dams in the process of monitoring, inspection, development of a reconstruction project and its expertise. As a result of the research, the dependence of the probability of the failure pfailure on the average value of the Iср index has been established and the graph “pfailure – Iср” is presented, which is well described by the exponential and is convenient for practical application. The value of I ср is determined according to the data of visual and instrumental control of the dam condition of the as well as according to expert estimates. The methodology for creation the indicated graph is presented. The creation of this graph became possible on the basis of: statistical processing, proof of the “normality” of the distribution of the I indices and the estimation (according to the distribution functions constructed for each level of damage) the probability of the failure pfailure, as well as during the survey and examination of the dam project. Proposals are formulated for the practical application of the proposed methods for assessing the risk of operating dams, and the near-term prospect of research in the field of risk assessment and ensuring dam safety is formulated.

Urgent Breast-Related Consults Seen by Acute Care Surgery at a Safety Net Hospital

Background Classically, urgent breast consults are seen by Breast Surgery or Surgical Oncology (BS/SO). At our safety net hospital, Acute Care Surgery (ACS) performs all urgent surgical consultations, including initial assessment of breast consults with coordinated BS/SO follow-up. The objective was to determine safety of ACS initial assessment of acute breast pathology. Methods All urgent breast-related consultations were included (2016-2019). Demographics, consult indications, and investigations/interventions were captured. Outcomes were compared between patients assessed by ACS versus both ACS and BS/SO at presentation. Results 234 patients met study criteria, with median age 39 years. Patients were primarily Hispanic (82%) women (96%). Most were not seen by BS/SO at presentation (69%), although BS/SO assessment was more frequent among patients ultimately diagnosed with cancer (8% vs 1%, P = .012). No patient had delay >90 days to core biopsy from presentation. Outcomes including time to cancer diagnosis (14 vs 8 days, P = .143) and outpatient BS/SO assessment (16 vs 13 days, P = .528); loss to follow-up (25% vs 21%, P = .414); and ED recidivism (24% vs 18%, P = .274) were comparable between patients seen by ACS versus ACS/BS/SO at index presentation. Conclusion Urgent breast consults at our safety net hospital typically underwent initial assessment by ACS with outpatient evaluation by BS/SO. Time to follow-up and cancer diagnosis, loss to follow-up, and ED recidivism were similar after index presentation assessment by ACS versus ACS and BS/SO. In a resource-limited environment, urgent breast consults can be safely managed in the acute setting by ACS with coordinated outpatient BS/SO follow-up.